Revenue CycleThe revenue cycle is known as the process by which healthcare providers receive reimbursement for care provided. Generating revenue is necessary for the efficient operation of any healthcare facility. The revenue cycle includes all stages involved in patient care, from arriving the patient, meeting their needs, and receiving payments for services provided (Gillikin). Factors Contributing to Revenue Cycle Complexity Several factors contribute to revenue cycle complexity. the income cycle. Frequent changes in payer contracts, legislative mandates, and care management are just a few examples of why the revenue cycle in healthcare is so complex. Additionally, issues that arise during the revenue cycle stages further complicate the entire process. For example, it is extremely difficult to effectively track the stages of the revenue cycle when it is managed by poorly trained staff. Additionally, if a healthcare provider does not have the proper information system to track patient records and billing, it may become difficult to obtain reimbursement. Additionally, one of the main factors that delays payments is refusals from insurance companies. Reasons for denial include incorrect coding, certain sequence of care, and medical necessity or even a delay in claims submission. Finally, ineffective correspondence with patients can not only hinder the revenue cycle process but also lead to numerous patient complaints (Wolper, 2004). Six Stages of the Revenue CycleThe six stages of the revenue cycle are providing the service, documenting the service, establishing the fee, preparing the claim/invoice, submitting the claim and receiving payment. The first step is to provide the ...... middle of paper ......0. CMS-1500 is the basic form defined by the Center for Medicare and Medicaid and is used by most outpatient clinics. CMS-1450 is the form used by hospitals to request reimbursement for hospital visits. While the CMS-1500 is used for patients covered by Medicare Part B, the CMS-1450 is used for patients insured by Medicare Part A. Some of the charges that must be claimed using the CMS 1500 are outpatient surgeries performed in a certified ambulatory surgery center. , all hospital clinics and hospital-based primary care practices. Additionally, some of the expenses that must be claimed in the CMS-1450 are emergency department visits, ancillary department visits, outpatient services such as infusion therapy or observation, any services rendered during 'a hospital visit and any pathology services provided independently of the patient. presence (Ferenc, 2013).